Abstract
BACKGROUND: Rhythm control therapy improves the quality of life and prognosis of patients with atrial fibrillation (AF). We assessed the characteristics and clinical outcomes of AF patients with stable coronary artery disease (CAD) undergoing rhythm control therapy. METHODS: We analyzed 2215 participants from the Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial, including 588 patients who received rhythm control therapy and 1627 who did not. RESULTS: At baseline, patients who received rhythm control therapy were generally younger, exhibited a higher prevalence of paroxysmal AF, experienced less heart failure, and had lower CHADS2 scores (CHF, hypertension, age ≥ 75 years, type 2 diabetes, and previous stroke or transient ischemic attack [doubled]) than those who did not. Among the rivaroxaban monotherapy and combination therapy groups, patients with a history of rhythm control therapy showed a lower incidence of the primary efficacy endpoint (a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death). However, following multivariate analysis and propensity score matching, no statistically significant difference in the primary efficacy endpoint was observed between patients with and without prior rhythm control therapy (adjusted HR 0.75, 95% CI 0.37-1.51, p = 0.43 in the rivaroxaban group; adjusted HR 0.75, 95% CI 0.43-1.30, p = 0.30 in the combination therapy group). CONCLUSIONS: The initially observed benefit of rhythm control therapy was not significant after adjusting for baseline characteristics in patients with AF and stable CAD treated with rivaroxaban with or without additional antiplatelet therapy.